2008-627 TOVN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518) 761-8201
Community Development- Building &Codes (518) 761-8256
CERTIFICATE OF COMPLIANCE
Permit Number. P20080627 Date Issued: Monday, December 01, 2008
This is to certify that work requested to be done as shown by Permit Number P20080627
has been completed.
Tax Map Number. 523400-278-000-0001-027-000-0000
Location: 491 STATE ROUTE 149
Owner. JEFFREY & NANCY WEILS
Applicant: JEFFREY &NANCY WEILS
This structure may be occupied as a:
Septic Alteration Residential
By Older of Town Board
TOWN OF QUEENSBURY
Issuance of this Certificate of Compliance DOES NOT relieve the
property owner of the responsibility for compliance with Site Plan, '
Variance, or other issues and conditions as a result of a rovals b the
pp y Director of Building Code Enforcement
Planning Board or Zoning Board of Appeals.
TOWN OF QUEENSBURY
742 Bay Road,Queensbury,NY 12804-5902 (518)761-8201
Community Development- Building&Codes (518) 761-8256
BUILDING PERMIT
Permit Number: P20080627 Application Number. A20080627
Tax Map No: 523400-278-000-0001-027-000-0000
Permission is hereby granted to: JEFFREY&NANCY WEILS
For property located at: 491 STATE ROUTE 149
in the Town of Queensbury,to construct or place
at the above location in accordance with application together with plot plans and other information hereto filed
and approved and in compliance with the NYS Uniform Building Codes and the Queensbury Zoning
Ordinance. Type of Construction Value
Owner Address: JEFFREY&NANCY WEILS
Septic Alteration Residential
491 STATE ROUTE 149
LAKE GEORGE,NY 12845 Total Value
Contractor or Builders Name/Address Electrical Inspection Agency
Plans &Specifications
2008-627
septic alteration residential
$25.00 PERMIT FEE PAID- THIS PERMIT EXPIRES: Tuesday,December 01, 2009
(If a longer period is required,an application for an extension must be made to the code Enforcement Officer
of the Town of Queensbury before the expiration date.)
Dated at of e uryyj �.Mvffday,December 01,2008
SIGNED for the Town of Queensbury.
Director of Building&Code Enforcement
01___I I -._____ _ _.____OFFICE USE ONLY
TAX MAP NO. I PERMIT NO. FEE#2 (•(�
o
, ty � 5 Zoo
APPROVALS: ZONING _TOWN CLERKo 0
_- :.........................
APPLICATION FOR SEPTIC DISPOSAL SYSTEM PERMIT:
A PERMIT MUST BE OBTAINED BEFORE WORK BEGINS.APPLICATION IS SUBJECT TO REVIEW BEFORE ISSUANCE OF A VALID
PERMIT. t �
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OWNER: INSTALLER: A i cl h 1 4u c o E
ADDRESS: <' C y ADDRESS:
PHONE NOS. � q PRONE NOS.
LOCATION OF INSTALLATION: 4 z
RESIDENCE INFORMATION:
YEAR BUILT NO.OF X COMPUTATION= = TOTAL DAILY FLOW
BEDROOMS GARBAGE GRINDER
1980 or older X 150 gallon per bedroom INSTALLED? z(,l -
1981 -1991 X 130 gallon per bedroom =
SPA OR HOT TVB
1992-present X 110 gallon per bedroom = INSTALLED?
PARCEL INFORMATION:
✓ TOPOGRAPHY: Flat rolling_ Steep slope %Slope
✓ SOIL NATURE: Sander Loam Clay Other
✓ GROUNDWATER: At what depth? rA
✓ BEDROCK/IMPERVIOUS MATERIAL: At what depth?
✓ DOMESTIC WATER SUPLY: Municipal We'd_// (If well: Water supply from, any septic
system absorption is ft.)
r �
✓ PERCOLAT ION TEST: Rate is minutes per inch [MPI]
(Test to be completed by a I tensed professional engineer or architect.)
PROPOSED SYSTEM FOR NEW CONSTRUCTION: All individual sewage disposal systems must be designed by
a licensed professional engineer or architect(unless installed in a Planning Board approved subdivision).
TANK SIZE: Wiz? GALLON (MIN. SIZE IS 1,000 GAL.)Add 250 gallons to the size of the septic tank for
each garbage grinder, spa or whirlpool tub.
SYSTEM TYPE:
❑ ABSORPTION FIELD (WITH NO. 2 STONE) Total length eft. Each trench �X `
❑ SEEPAGE PIT(S)(WITH NO. 3 STONE) How many? Size?
❑ ALTERNATIVE SYSTEM Bed or other type?
❑ HOLDING TANK SYSTEM Total required capacity?
Tank size? Number of tanks?
NOTE: ALARM SYSTEM AND ASSOCIATED ELECTRICAL WORK MUST BE INSPECTED BY A TOWN
APPROVED ELECTRICAL INSPECTION AGENCY. PLEASE REVIEW LIST PROVIDED.
For your protection, please note that pursuant to Section 136-29 of the Code of the Town of Queensbury, any
permit or approval granted which is based upon or is granted in reliance upon any material misrepresentation or
failure to make a material fact or circumstance known by or on behalf of an applicant, shall be void.
I have read the regulations with respect to this application and
agree to abide by these and all requirements of the Town of QUESTIONS? CALL 761-8256 OR EMAIL
Queensbury Sanitary Sewage Disposal Ordinance. coaes(aaueensburv.net
_ VISIT OUR WEBSITE FOR MORE INFORMATION
www.aueensbury.net
Signature of Person Responsible ponsible Date
Tou `of Queensbury ■ Community Development Office ■ 742 Bay Road, Queensbury, NY 12804
B 5-LGL 6/06
Septic Inspection Report c
Office No. (518) 761-8256 Date Inspection request received:
Queensbury Building &Code Enforcement Arrive: am/pm Depart: -J21 �4" am/pm
742 Bay Rd., Queensbury, NY 12804 Inspector's Initials:
s
NAME: M r (a", 2 � , 11�_L)5 PERMIT NO.:
LOCATION: ( .< i `�T INSPECT ON:
RECHECK:
Comments and/or diagram
Sal T : Sand Loam/ Clay
Type of Water: Munid i eli Wa
Waterline separation distance ft.
Well separation distance ft.
Other wells: ft,
Absorption Field: Total length
Length of each trench ft.
Depth of trenches '' ft.
Size of Stone -Z
.Seepage Pits: Number
Size: x
Stone Size:
Pi i Size Twe
Building to tank
Tank to Distribution Box 4 `
Distribution Box to 'eld Pit
O ni Sealed: Partia
End Ca
Inlet/Outlet Pipes&Baffles N
Location Separations
Foundation to tank ft.
Foundation to absorption ft.
Separation of Pits AV Ift,
Conforms as per Plot Plan Y N
Engineer Rep2rt and As-Built N
Location of System roperty:
Front ear eft Side Right Side
Middle Front le Rear
m t
Approved
Partial Approved and needs to be re-inspected, please Cali the Building &Codes Office
Disapproved
Last revised 021006
Last revised 1/6/05
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